COMMUNITY CARE FOR THE ELDERLY IN MILWAUKEE, WIS. APPROVED FOR HEALTH CARE PROGRAM FOR FRAIL ELDERLY

COMMUNITY CARE FOR THE ELDERLY IN MILWAUKEE, WIS. APPROVED FOR HEALTH CARE PROGRAM FOR FRAIL ELDERLY

The Centers for Medicare & Medicaid Services (CMS) and the state of Wisconsin Department of Health and Family Services have approved a request by Community Care Organization Inc. in Milwaukee, Wis., to become a provider under a permanent program of comprehensive care that allows the frail elderly to live in their communities.

Community Care Organization Inc. is part of the Program of All-inclusive Care for the Elderly (PACE), an optional benefit under Medicare and Medicaid that focuses entirely on older people who are frail enough to meet their state's standards for nursing home care. The program brings together all the medical and social services needed for someone who otherwise might be in a nursing home.

"PACE programs such as the Community Care Organization Inc. offer the care and services that many frail, older Americans need to live in their communities instead of nursing homes," Health and Human Services Secretary Tommy G. Thompson said. "Under President Bush's New Freedom Initiative, we are working to help all Americans with disabilities live more independently and participate more fully in community life."

"We are pleased to have another permanent PACE organization," CMS Administrator Tom Scully said. "PACE gives frail people covered by Medicare or Medicaid the opportunity to live at home close to their loved ones, while also receiving the care they need. Community Care Organization Inc. has become a productive, ongoing effort that will now be reimbursed, on a permanent basis, by the two health care programs. This is a result of the successful relationship forged among state and federal agencies, providers and foundations during the pilot project phase.”

Community Care Organization Inc. joined the PACE demonstration program in 1990 and now has about 420 beneficiaries.

Most beneficiaries in the plan are eligible to receive services under both the Medicare and Medicaid programs. The plan operates three PACE centers in Milwaukee at 1555 S. Layton Blvd., 5228 W. Fond du Lac Ave. and 1825 N. Prospect Ave. Kirby Shoaf is the plan’s chief executive officer.

A team, including a physician, registered nurse, therapists and other health professionals, assesses the participant's needs, develops a comprehensive plan of care and provides for total care. Generally, services are provided in an adult day health center, but also may be given in the participant’s home, a hospital or long-term care facility in a nursing home.

PACE is available only in states that have chosen to offer the program under the Medicaid state plan. To be eligible for PACE, a person must be 55 or older, live in the service area of a PACE organization, be able to live safely in the community and be certified as eligible for nursing home care by the state.

Enrollment is voluntary, and once enrolled, PACE becomes the sole source of all Medicare and Medicaid covered services, as well as any other items or medical, social or rehabilitation services the PACE interdisciplinary team determines an enrollee needs. If a participant requires placement in a nursing home, PACE is responsible and accountable for the care and services provided and regularly evaluates the participant’s condition.

PACE began as a demonstration project in San Francisco. A regulation published Nov. 24, 1999, implemented legislation establishing PACE as a permanent part of the Medicare program and included provisions that enable PACE demonstration sites to convert to permanent status.

A PACE organization receives a fixed monthly payment from Medicare and Medicaid for each participating beneficiary, depending on their Medicare and Medicaid eligibility. The payments remain the same during the contract year, regardless of the services a participant may need.